Provider Demographics
NPI:1801877840
Name:YASKO, DIRK
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:
Last Name:YASKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 NORREL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2679
Mailing Address - Country:US
Mailing Address - Phone:205-655-0123
Mailing Address - Fax:205-655-0466
Practice Address - Street 1:4735 NORREL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2679
Practice Address - Country:US
Practice Address - Phone:205-655-0123
Practice Address - Fax:205-655-0466
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
481303Medicare UPIN